2024 EAU Prostate Cancer Guidelines - some big changes!!
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- Опубликовано: 18 июн 2024
- Pelvic lymph node dissection down-graded. Systematic prostate biopsies no longer recommended. More clarity around PSMA PET/CT for staging. Surgery no longer recommended for cN1 prostate cancer. Yep the recent updates to the EAU Prostate Cancer Guidelines had a lot of important changes for the global urology community to digest. So we invited EAU Prostate Cancer Guideline Vice-Chair Derya Tilki, and Guideline Board Member Gianluca Giannarini, along with Elio Mazzone to join us for a deep dive into these major changes. All you need to know!
Also available as an audio podcast - just search GU Cast wherever you get your podcasts 
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Thank you Doctors. This was very interesting. My husband was just diagnosed so we are trying to learn all we can.
Sorry to hear that Barbara. We hope that all goes very well for him. Declan and Renu
I’m listening with interest in the hope there is some new treatments being considered. My husband had his prostate removed in October last year. He had a Gleason score of 4+5 and post surgery it was upgraded to 5+4. It was borderline breaking out he was told after the pathology, however they were content with how things had gone. He has had 2 PSA tests since surgery, both negligible score but the most recent has showed a PSA level of 0.89. He is pretty devastated and we are waiting for a PET scan. Until this is done we have no idea where it’s popped up again and so I’d appreciate any advice you can give us.
Loved it, thank you
Glad you enjoyed it Baz! Declan and Renu
Thank you for your channel. It is really helpful! I live in the US. My RP and e PLND is scheduled for next week. I'm really concerned about PLND due to its possible life-long complications. My circumstances are as follows: Firm yet no nodular DRE. MP MRI showed 1cm lesion in the peripheral zone with no ECE. PSA 19.4 yet at the time I had CP/CPPS. Systematic biopsy showing (1) 4+4, (4) 4+3 and (1) 3+3. Gleason 8. PSMA Pet showed avidity in only the prostate. No other avidity at distant sites including the nodes and seminal vesicles. BRCA 1 and 2 negative. I'm also asymptomatic in the pelvic region. I'm wondering that, in my setting, can I forego the ePLND? My thinking is to go ahead with the RP only, test PSA every 3 months for two years and if it starts to rise, repeat the PSMA to find it then deal with it. Thanks so much!
Hi Richard. First of all, so sorry to hear about your diagnosis. It certainly sounds like an important diagnosis as that is a proper cancer. We are very happy to hear that your PSMA PET/CT is all clear. The discussion about PLND remains contentious and advice is changing. We very much respect what individual surgeons recommend and we totally respect the fact that it is up to the individual patient at the end of the day. We encourage people to use the excellent nomogram published by Gandaglia et al in European Urology Oncology a few months ago which is aimed at patients who have had a PSMA PET/CT showing no disease outside the prostate (like you). We featured this on GU Cast a few months ago with Dr Gandaglia. On that nomogram thankfully, your risk of having positive lymph nodes is extremely low indeed which is good news. We wish you all the very best with your surgery. Declan and Renu
@@gu_cast Thanks so much for your reply and information.
@@gu_cast Hey y’all. Hope you’re doing great. I met with my surgeon today before tomorrow’s RP to express my concerns about the PLND planned. I laid out all I learned about it and he agreed there was no benefit in doing it other than for diagnostic staging. Thank y’all for that video posted about the subject so it’s not being performed . Just wanted to let you know.
I did not understand why I had to suffer a biopsy. PSA 2000, bone scan showed extensive mets to upper skeleton, I mean everywhere. PSMA PET Scan after biopsy simply confirmed the bone scan and showed-up a met in a pelvic lymph node. The biopsy was done after the bone scan for what? All it did was raise my PSA to 3500 and I was put on ADT immediately anyway. Result of the biopsy - I couldn't sit down for a week and needed a catheter for six weeks afterwards. It's eventual removal was horrendous for two days after, pissing pure blood, then pushing clots until it cleared up. I sometimes wonder if you doctors and the guidelines you follow understand anything. From what I can make out all it did was give me a Gleason 9 diagnosis, SoC sucks.
So sorry to hear your story Mark. That is a really tough situation and I am really sorry to read your story. That is about as tough as it gets and I hope that you are going ok and that you have good people looking after you. We still often offer biopsy in these situations (even if the diagnosis and management is already clear), as it can help when trying to get access to clinical trials and certain treatments like PARP inhibitors. But really sorry to hear this and hope things are looking up for you. Sending you best wishes from Melbourne. Declan
@@gu_cast I'm doing OK thanks. Eight months into diagnosis. I live in Thailand so I'm not eligible for clinical trials here. What really makes a difference to me is to receive a reply from someone like yourself and to know someone is listening and understands. Thank you for taking the time to reply. Mark.
If systematic biopsy is still recommended for focal treatment planning, what happens if the initial focused biopsy turns up PCa that requires treatment? Does the patient then have to undergo a systemic biopsy for focal treatment planning?
Myself and Renu don't do focal therapy so we are hesitant to answer. Focal therapy still considered investigational in the EAU guidelines so only recommended in clinical trials or prospective registries. Best direct that question to a focal therapy specialist. However, updated EAU Guidelines no longer recommend systematic biopsy in men who have an MRI lesion - recommend just target teh lesion and area surrounding it. Good discussion in this podcast. But let's do a podcast on focal therapy soon. Declan and Renu